Minimally-Invasive Spinal Fusion

Lumbar fusion surgery has become less invasive in recent years, thanks to the use of a new device that allows surgeons to split or move muscle apart instead of cutting it away in order to access the spine.

Use of the device, called a tubular retractor, allows for less destruction of muscle tissue, and results in less pain, a faster recovery, and more successful operations, says Dr. Kevin J. McGuire, Chief of Orthopaedic Spine Surgery and co-Director of the Spine Center at Beth Israel Deaconess Medical Center in Boston.

“This minimally invasive approach allows patients to get out of the hospital quicker, and by mobilizing them more quickly, we can avoid some of the complications of surgery that result from inactivity,” he says.

Surgeons must get past the muscle that surrounds the spine to perform the fusion itself.

But one of the most common reasons why lumbar fusion surgery can fail is when damage to the muscles, as the result of the surgery, leaves patients with pain that they didn’t have going in, according to Dr. McGuire.

“Their leg pain may be gone but they are left with back pain from the surgery,” he says.

The minimally-invasive approach does less damage to those muscles since it uses a tube to split the muscle fibers apart rather than cutting, burning, or stripping the muscle away from the spine to get the necessary exposure. The technique, which also allows for the use of smaller incisions, can only be used in certain types of spinal fusion operations. It is most appropriate for one- and two-level fusions and certain cases of spinal stenosis and disc removals.

“There is only so much you can do through a tiny tube,” Dr. McGuire says. “But for these indications, it is very nice.”

John Ennis of South Easton had the minimally-invasive procedure done in at BIDMC and he is pleased with the results.

He says he had been in extreme pain for several years after a work accident and was on pain medications “that weren’t doing any good. I had to do something. The pain was going down my leg and into my ankle.”

Ennis says he was up walking in the hospital before he was discharged.

“Within a week, I was walking a mile,” says the 78-year-old former maintenance mechanic.